Transfusion Medicine Things to Review Flashcards
(83 cards)
1
Q
Antigens Enhanced with Enzymes (Ficin, Papain)?
A
A Rotten Kidd ABO-related ABO-H Lewis System I System P System Rh System Kidd System
2
Q
Antigens Decreased with Enzyme (Ficin, Papain)?
A
My Dog Lassie MNS System Duffy System Lutheran System
3
Q
Dose Dependent Antigens?
A
Kidd, Duffy, Rh, MNS
4
Q
Neutralizing Substance: ABO
A
Saliva (Secretor)
5
Q
Neutralizing Substance: Lewis
A
Saliva (secretor for Le^b)
6
Q
Neutralizing Substance: P1
A
Hydatid cyst fluid Pigeon egg whites
7
Q
Neutralizing Substance: Sd^a
A
Human urine
8
Q
Neutralizing Substance: Chido, Rodgers
A
Serum
9
Q
Determining A1 vs. A2 present?
A
Dolichos biflorus
10
Q
Lectin for H Specificity?
A
Ulex europaeus (causes antigluttination)
11
Q
Lectin: N Specificity
A
Vicea graminea
12
Q
Lectin: T Specificity
A
Arachis hypogea
13
Q
Lectin: T, Tn Specificity
A
Glycine max
14
Q
Lectin: Tn specificity
A
Salvia
15
Q
General: Warm vs. Cold Antibodies
A
Warm: IgG Exposure HDFN HTRs Significant Cold IgM Naturally Occcuring No HDFN No HTR Insignificant
16
Q
Type 1 vs. Type 2 Chains
A
Type 1: Secretion -B1-3 -H is made by FUT2 genes Type 2 Chains: -B1-4 -RBC Membranes H is made by FUT1 genes
17
Q
Terminal Sugars (A vs. B)
A
A: GalNac N-acetylgalactosamine B: Gal Galactose
18
Q
What Chromosome are A,B,O genes on?
A
Chromosome 9
19
Q
Different between A and B vs. AB antibodies?
A
A and B produce IgM antibodies ***Cannot cross the placenta Group O: Anti-A,B is IgG
20
Q
A1 vs. A2
A
80% A1 20% A2 A1 has 5x as many antigen than A2 1-2% A2, 25% A2B form anti-A1: Insignificant unless 37 C
21
Q
Acquired B Phenotype
A
A1 RBC contact enteric Gram Negative organisms Colon cancer, GI obstruction, Gram(-) sepsis AB forward typing A reverse typing Result of deacytlation of A1 sugar –> making it look like a B sugar
22
Q
How do you resolve an Acquired B Phenotype?
A
Acidify serum (pH 6.0) Use monoclonal anti-B that does not recognize acquired B
23
Q
Bombay Phenotype
A
Do NOT have an H antigen on the phenotype Have strong anti-A, anti-B, anti-H
24
Q
Le gene (FUT3)
A
Allows you to make Lewis A
25
Le gene (FUT3) and Secretor Gene (FUT2)
Can make Lewis A and Lewis B
26
Lewis antigens
Adsorb onto surface of RBCs Le^b much better than Le^a Therefore, adult RBCs are usually Le(a-b+)
27
Clinical Significance of Lewis Antibodies?
Clinical Insignificant Usually IgM Also, Fetal RBCs lack Le antigens...cord blood is Le(a-b-)
28
H.pylori, Norwalk virus attach via which antigens?
H, Le^b
29
H.pylori, Norwalk virus attach via which antigens?
H, Le^b
30
Le(a-b-) children are increased susceptibility to what?
E.coli UTI's
31
I System
ABO-related, Type 2 Chains I in adults, i in children (Big I in adults, little i in kids) Little i = linear branch
32
Auto-anti-I
Mycoplasma pneumonia Cold agglutinin Disease
33
Auto-anti-i
Infectious mononucleosis
34
P-Group
P1 only official antigen P is the receptor for Parvovirus Anti-P1 is cold, insignificant IgM
35
Paroxysmal Cold Hemogloinuria (PCH)
Biphasic IgG vs. P antigen Attaches when cold Complement attaches when heated Donath-Landstiner biphasic hemolysin Causes: Syphilis Now viral infections in kids
36
Rh Blood Group, Fisher-Race Notation
If "R" is capital...you have a big D If "r" is lowercase...you have a little d... R1 or r' means capital C R2 or r'' means lowercase E R0 means Dce r = dce Rz = DCE r^y = dCE
37
Rh Antibodies
* Exposure requiring war-IgG
* HTR's, primarily extravascular
* Prototypic HDFN with anti-D
* Severe HDFN with anti-C
38
Frequency of Rh Antigens
39
Partial D
* Lack certain D epitopes on exterior part of RBC via RHD mutation
* Antigens to the missing parts....anti-D
40
Kidd Blood Group
* Jk^a \> Jk^b (Rule of B exception)
* Exposure requiring warm IgG
* Dose depdendent
* Delayed HTR's
* Mild HDFN at worst
41
MNS Blood Group
* Glycophorin A and B
* Glycophroin A: M and N
* Glycophorin B: S, s, and U
* Frequencies:
* M = N
* s \> S
* S-s-U- in 2% of African Americans, but never in Caucasians
42
MNS Antibodies
* Anti-M and -N
* "Natural"
* IgM
* Insignificant
* Anti-S, -s, and -U
* Exposure
* IgG
* Significant
43
Duffy Blood Group
* Fy^a and Fy^b are the main antigens
* 68% of African Americans are Fy(a-b-)
* The FyFy genotype --\> Fy genotype produces no Duffy glycoprotein on RBC's
* Exposure requiring warm IG
* Marked dosage (like Kidd)
* Variable expression (like Kidd)
* Delayed HTR's (like Kidd)
44
Malaria Resistance
* Fy(a-b-) Resistant to Plasmodium vivax infection
* Duffy glycoprotein is receptor for P.vivax merozites
How to remember: Duffy ends with a "y"....vivax also ends with "x"....both near the end of the alphabet.
45
Kell Blood Group
* K = K1, 9% Caucasians, 2% AA
* k = K2, 99.8% of population has
* Js^b, Js^a, Kp^b, Kp^a
Note:
* Kx
* Xk protein expresses Kx blood gropu antigen
* Closely attached to Kell antigens on RBC surface
46
Kell Antibodies
* Anti-K
* Most common after D
* Exposure requiring warm IgG
* Severe HRT's andHDFN
* Anti-k
* Like Anti-K....just uncommon
47
McLeod "syndrome"
* X-linked
* Absence of Kx
* Decreased Kell antigens
* Acantholytic hemolytic anemia
* Chronic Granulomatous Disease association
48
Who regulates Allogeneic Donation?
FDA!
AABB accredited (can't shut things done...but people need for business)
49
Deferrals for variant CJD
* 3 months in UK (1980-1996)
* 6 months in Military in europe (1980-1996....they got beef from England)
* If you lived in Europe for 5 years (1980-now)
*
50
Immunizations (Deferrals)
* Four Week
* Rubella
* Varicella
* Two Week
* Measles
* Mumps
* Oral Polio
* Yellow Fever
* Oral Typhoid
* Unlicensed:
* 12 months
51
Medication Deferrals
* Anti-platelet issues
* ASA: 48 hours
* Clopidogrel, Ticlopidine, Vorapaxar: 2 weeks
* Herparin/Warfarin: Plasma Products: 7 day deferral
* DTI: 2 day deferral
52
Physical Criteria for Donating
* Weight: \>110 lbs
* Temperature: \<99.5F (we only test platelets for bacteria)
* Pulse: 50-100
* BP: 90-180/50-100
* H/H:
* Females: 12.5 g/dL, 38%
* Males: 13.0 g/dL, 39%
53
How much blood do you draw?
* Amount drawn: 500 +/- 50 mL
* Can't do more than 10.5 mL/kg samples!
Time Limit:
* More than 15 minutes, only make RBCs
54
Age for Blood Collection
* 15-17 y/o depending on state
55
Concerns for Autologous Transfusion
* Donor reactions
* Clerical errors
* Bacterial contamination
* TACO (Transfusion Associated Circulatory Overload)
* Cost (over 50% tossed)
* Time (too close to surgery...can't get back)
* Positive RTTI Tests
56
Platelet Donors
* Hgb = same as Whole Blood Donors
* \>48 donors between single donations
* 7 days between double/triples
* Only up to 2x per week, 24 times/week
* Must wait 8 weeks after Whole Blood Donation
* Pre-count: \>150,000
57
Who do you have to weigh before donation?
* Only plasma donators!
* 14.4 L for donors weight \> 175 lbs
58
Double RBC Donors
* Remember 8 week for WB
* 4 to recover RBC's, 4 for safety
* 2 RBC Unit Donation:
* 16 weeks!
* 8 for recovery, 8 for safety
59
Vasovagal Reaction vs. Hypovolemia vs. Hyperventiliation
* **_Bradycardia_**
* Hypotension
* Syncope
* N/V and incontinence
* Tx: Elevate feet, reassure, cold compresses on neck
Hypovolemia:
* **_Tachycardia_**
* Hypotension
* Syncope
* Tx: IV Fluids
Hyperventilation:
* SOB
* Seizures (rare)
* Tx: Breath into a paper bag
60
Arterial Puncture
* Rapid filling of bag (less than 4 minutes)
* Bright red blood
* Pulsatile or vibration of needle
* Rapidly expanding hematoma
* Risks:
* Hematoma: 50-100 times more common
* Nerve compression
* Pseudoaneurysm
* Compartment Syndrome
* Tx: Stop Collection!
* Direct pressure for AT LEAST 10 minutes!
* If no radial pulse...call ED or call medical director
* Wrap with Coban
* Advise donor to avoid strenousd activity: 4 hours minimum
61
Pseudoaneurysm
* Leakage of blood into surrounding tissue with persistent communciation.
* Clot forms -- compresses nearby structures
* On X-ray....look like an aneurysm.
* Doppler can diagnose (movement of fluid into sac)
* Tx: Surgical repair
62
Arteriorvenous Fistulas
* Bruit over left antecubital fossa
* Needle punctures vein and artery creating "connection"
* Requires surgical repair
63
Infection from Donation
* Source:
* Improper scrub technique
* Never re-palpate after insertion
* Sx:
* Rubor: Erytheme
* Calor -- local heat
* Dolor: Pain
* Tumor: Swelling
* Tx: Antibiotics!
64
Citrate Effect
* Anticoagulant binds free calcium
* Perioral tingling
* Tetany and arrhythmias very uncommon
* Tx:
* Oral calcium
* Slow rate of infusion!
65
3 Day Rule for Cross-match
* If you collect a sample, it can be used for cross-match for any transfusion up to 3 days, NOT 72 hours.
* Example:
* You collect sample Sunday at 2 pm
* Can be used for cross-matched for any transfusion until Wednesday at midnight.
* Thursday --\> need a new sample.
66
Type & Screen
vs.
Type & Crossmatch
67
Anticoagulant/Preservatives
* CPD and CP2D: 21 day Red cell storage
* CPDA-1: 35 day Red cell storage
* Acid Citrate Dextrose (ACD): 21 days: apheresis collections
68
Why do we have Additive Solutions?
* Result in a product with more adenine for ATP generation
* AS-1 and AS-5 have mannitol for RBC preservations
* Allow for 42 day storage (+1 week)
69
Red Blood Cells
* 350 mL (including additive)
* RBC's
* Plasma
* WBCs and PLTs
* Anticoagulation
* Addictive solution
* 200-250 mg Iron
70
AABB Recommendations for Transfusion
* Hospitalized, hemodynamically stable patients;
* Adult and Pediatric ICU: 7 g/dL or less
* Post-op patients:
* 8 g/dL or less
* Or Sx!
* Hospitalized, hemodynamically stable patients with preexisting cardiovascular disease:
* Hemoglobin: 8 g/dL or less
* OR Sx
71
RBC Dosing
* Hematocrit increased 3%
* Hgb increased 1 g/dL
* Non-bleeding, non-hemolyzing patient
* Obtain s/p 10-15 minutes
72
RBC Storage Details
* RBC:
* 35 days with CPDA-1
* 42 days with AS (Additive Solution)
* Frozen RBCs (40% Glycerol)
* 10 years at -65 C
* Washed RBCs
* 24 hours, 1-6 C
* Irradiated:
* Original expiration date or 28 days (whichever is sooner)
73
What Fluids are Compatible with Transfusion?
* Normal saline
* ABO compatible plasma
* 5% albumin
74
Apheresis Platelets
* Must have 3.0 x 10^11 platelets
75
Platelet Shelf Life?
* 5 days
* Whole-Blood Derived: 4 hours...
76
Platelet Recommendations
* Give at \<10,000
* Lumber Puncture
* 50,000
* Prophylactic Plt Transfusion:
* Nonneuraxial surgery
* Cardiopulmonary bypass
* If there's perioperative bleeding
77
Leukocyte Reduced Products
* \<5 x 10^6 WBC's per unit
* Benefits:
* Decrease febrile transfusion reactions
* Decreased HLA immunization
* Foreign HLA antigens are presented by donor lymphocytes
* May lead to formation of HLA antibodies
* Decreased CMV transmission
* CMV ONLY in WBC's
* Contraindications!
* Don't use it in Transfusion-Associated GVHD
* Frozen Products don't have enough WBC's to help
* Granulocytes -- why? You're collecting the white cells
78
Transfusion Associated Graft vs. Host Disease
* Rare
* Fever 7-10 days, rash, mucositis, hepatitis, marrow fibrosis/aplasia
* Symptoms:
* BONE MARROW FAILURE
* Almost always failure
79
Prevention: Irradiation
* Dose:
* 25 Gy to central portion of container
* 15 Gy to any point in the components
* This will inactive donor lymphocytes...which will cause GVHD
80
Why Wash Blood?
* Remove "allergic" plasma proteins
* IgA deficiency
* Allergic reactions refractory to medical therapy (e.g., refractory to steroids)
* Neonatal Alloimmune Thrombocytopenia
* Anti-HPA-1A in 80%
* Unwanted electrolytes -- pediatric patients
81
Cryoprecipitate
* Plasma doesn't need QC....
* Minimum Requirements:
* 150 mg Fibrinogen
* \>80 IU Factor VIII
* Other Components:
* vWf
* Factor VIII
* Factor XIII
* Fibronectin
* Storage: \<-18C for 12 months
When do you use it:
* Fibrinogen deficiency
* Congenital
* Acquired
* Treatment of vWD
* Bleeding Uremic patients (after DDAVP)
* Fibrin Glue
Note: NO Factor VII
82
Granulocytes
* Stored at 20-24 C (no agitation)
* 24 hour storage period
* ABO compatible
* As required:
* CMV negative
* HLA compatible
* Irradiated
* Indications:
* Severe neutropenia (\<500/uL)
83
DDAVP
